Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
Cancer Med. 2021 Jan;10(2):605-614. doi: 10.1002/cam4.3629. Epub 2020 Dec 6.
Based on the eighth TNM staging system, T3a renal cell carcinoma (RCC) is identified as an anatomical extrarenal invasion and does not consider the size of the tumor; however, it may not fully predict the prognosis of the patient. The objective of this study was to evaluate the prognostic value of tumor size effects on prognosis in T3a RCC and propose an alternative tumor stage system combined with T1-2.
Data relating to T1-3aN0M0 RCC (n = 49586) were obtained from the Surveillance, Epidemiology, and End Results database (2004-2015). Survival analyses were conducted by Cox regression and Fine and Gray regression. Harrell's concordance index (c-index) was used to assess the discriminatory ability of the prognostic factors.
A 1-cm increase in T3a RCC resulted in an 8% increase in all-cause mortality (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06-1.10, p < 0.001) and 14% increase in the risk of RCC-specific mortality (sub-distribution HR [sHR]: 1.14; 95% CI: 1.11-1.16, p < 0.001). T3a tumor size stratified by the cutoff of 4 cm and 7 cm showed a better prediction of RCC-special survival (c-index: 0.644), compared with a cutoff just by 4 cm (c-index: 0.571) or by 7 cm (c-index: 0.602). Compared with T1b tumors, T3a RCC ≤4 cm showed no differences in terms of all-cause mortality (HR: 0.93; 95% CI: 0.79-1.09; p = 0.37) and mortality caused by RCC (sHR: 0.91; 95% CI: 0.70-1.19; p = 0.50). Last, the alternative T-staging system (T1a, a combination of T1b and T3a [≤4 cm], T2a, T2b, T3a [4-7 cm], and T3a [>7] cm) demonstrated good RCC-special survival predictive accuracy (c-index: 0.729), which was higher than that shown by the current eighth edition T-staging system (c-index: 0.720).
Tumor size should be taken into consideration for T3aN0M0 RCC rather than based on anatomical features alone.
基于第八版 TNM 分期系统，T3a 肾细胞癌（RCC）被定义为肾外解剖侵袭，不考虑肿瘤大小；然而，它可能无法充分预测患者的预后。本研究旨在评估 T3a RCC 中肿瘤大小对预后的影响，并提出一种与 T1-2 相结合的替代肿瘤分期系统。
从监测、流行病学和最终结果数据库（2004-2015 年）中获得 T1-3aN0M0 RCC（n=49586）的数据。通过 Cox 回归和 Fine 和 Gray 回归进行生存分析。Harrell 一致性指数（c-index）用于评估预后因素的判别能力。
T3a RCC 每增加 1cm，全因死亡率增加 8%（风险比[HR]：1.08；95%置信区间[CI]：1.06-1.10，p<0.001），RCC 特异性死亡率增加 14%（亚分布 HR[sHR]：1.14；95%CI：1.11-1.16，p<0.001）。按 4cm 和 7cm 截止值分层的 T3a 肿瘤大小在预测 RCC 特异性生存方面表现出更好的效果（c-index：0.644），而仅按 4cm（c-index：0.571）或 7cm（c-index：0.602）截止值分层则效果较差。与 T1b 肿瘤相比，≤4cm 的 T3a RCC 在全因死亡率（HR：0.93；95%CI：0.79-1.09；p=0.37）和由 RCC 引起的死亡率（sHR：0.91；95%CI：0.70-1.19；p=0.50）方面没有差异。最后，替代 T 分期系统（T1a，T1b 和 T3a[≤4cm]的组合，T2a，T2b，T3a[4-7cm]和 T3a[>7cm]）显示出良好的 RCC 特异性生存预测准确性（c-index：0.729），高于现行第八版 T 分期系统（c-index：0.720）。
对于 T3aN0M0 RCC，肿瘤大小应与解剖特征一并考虑，而不仅仅基于解剖特征。
